Threat Beliefs Research Articles

Reality Cheque: Different Methods of Eliciting Fear-Related Beliefs Reveal Multiple Representations of Threat

Influential models of fears and phobias suggest that irrational threat beliefs underpin excessive fear. Yet, many fearful individuals recognize their fear is not justified. Drawing on memory competition/multiple representations theory, we developed a novel, fear-relevant procedure, which reveals conflicting representations of threat. In three experiments (Experiment 1, N = 49, Experiment 2, N = 47, Experiment 3, N = 75), fearful and non-fearful participants not only provided Probability Ratings for fear-related outcomes in a fear-relevant exposure task, but placed Bets, with payoffs depending on what happened in reality. Fearful participants displayed much higher Probability Ratings than Low fear participants. However, Bets revealed far less consistent group differences, even when proximal to threat (Experiments 1 and 2), and differences between High and Low fear participants’ Bets disappeared when they could not be anchored to previous Probability Ratings (Experiment 3). A Neutral Betting task also showed that general betting strategies were comparable between groups. We suggest that these findings may reflect the multi-representational nature of belief, in which both adaptive and maladaptive representations of a feared object may exist in parallel, with personal and contextual factors determining which form of representation is retrieved or expressed. This perspective can provide insights into the complex interplay of adaptive and maladaptive beliefs that is a central focus of currently dominant therapies.

Longitudinal evaluation of COVID-19 vaccine hesitancy in the United States: analysis of the US Census Household Pulse survey

Addressing the challenge of vaccine hesitancy is crucial in managing public health crises like the COVID-19 pandemic. This study leverages the U.S. Census Bureau’s Household Pulse Survey to examine COVID-19 vaccine hesitancy, with a specific focus on the longitudinal tracking of vaccination beliefs and the influence of varying risk perceptions. It investigates how public attitudes towards vaccines evolve, influenced by changing perceptions of COVID-19 risk and vaccine safety. By applying Secondary Risk Theory (SRT), the research elucidates the relationship between different risk perceptions and vaccine hesitancy. We find that threat perception of COVID-19 and lack of trust in the vaccine demonstrate strong predictive value of increased vaccine hesitancy in comparison to other reasons for hesitancy such as access to vaccines, vaccine efficacy beliefs, or perceived secondary risks about vaccine side effects. Respondents with very low primary threat beliefs that COVID-19 is not a threat were 5.65 times more likely (β = 1.732) to intend not to be vaccinated in January 2021, decreasing to 2.70 times more likely to avoid vaccination (β = 0.995) in the December 2021.

Relations between changes in safety behavior, paranoid ideations, cognitive biases, and clinical characteristics of patients with a psychotic disorder over time

BackgroundSafety behaviors, both positive (maladaptive coping behavior) and negative (avoidance behavior), are used by people with paranoid delusions to avoid perceived threats. Safety behaviors contribute to the persistence of paranoid delusions by preventing disconfirmation of threat beliefs and may influence other psychiatric symptoms. This study investigated how changes in safety behaviors are related to changes in paranoid ideation, social anxiety, depression, cognitive biases and self-esteem over time. MethodsThis study included 116 patients diagnosed with a psychotic disorder (DSM-IV) and at least moderate levels of paranoid ideations (GTPS >40).The data were collected as part of a multi-center randomized controlled trial where patients were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). Assessments were completed at baseline (T0), after three months (T3) and after six months (T6). For all variables, change scores between T0 and T3 and T3 and T6 were calculated and Pearson correlations between change scores were computed. ResultsA decrease in total safety behavior was related to diminished paranoid ideation, social anxiety, and depression. No significant temporal associations were found between changes in safety behavior and changes in cognitive biases and self-esteem. Similar but less robust results were found for respectively negative safety behavior and positive safety behavior. ConclusionDropping safety behavior can be specifically targeted in behavioral interventions. Whereas there appears to be a relation with reduction in anxiety, paranoia, and depressive symptoms, changes in safety behavior do not seem to align with changes in cognitive thinking processes.

The generalization of threat beliefs to novel safety stimuli induced by safety behaviors

Safety behaviors are responses that can reduce or even prevent an expected threat. Moreover, empirical studies have shown that using safety behaviors to a learnt safety stimulus can induce threat beliefs to it. No research so far has examined whether threat beliefs induced this way generalize to other novel stimuli related to the safety stimulus. Using a fear and avoidance conditioning model, the current study (n=116) examined whether threat beliefs induced by safety behaviors generalize to other novel generalization stimuli (GSs). Participants first acquired safety behaviors to a threat predicting conditioned stimulus (CSthreat). Safety behaviors could then be performed in response to one safe stimulus (CSsafeShift) but not to another (CSsafe). In a following generalization test, participants showed a significant but small increase in threat expectancies to GSs related to CSsafeShift compared to GSs related to CSsafe. Interestingly, the degree of safety behaviors used to the CSsafeShift predicted the subsequent increase in generalized threat expectancies, and this link was elevated in trait anxious individuals. The findings suggest that threat beliefs induced by unnecessary safety behaviors generalize to other related stimuli. This study provides a potential explanation for the root of threat belief acquisition to a wide range of stimuli or situations.

Cognitive behavioural therapy treatment for a fear of hypoglycaemia within a primary care psychological therapy service: a case study

AbstractMany individuals with type 1 diabetes (T1D) experience a fear of hypoglycaemia (FOH) which can have detrimental consequences on management of blood glucose (BG) levels and quality of life. A cognitive behavioural therapy (CBT) graded exposure approach has been recommended to treat FOH. The purpose of this case study is to examine the effectiveness of CBT in treating FOH within the context of a primary care psychological therapy service. It was found that CBT treatment led to: a reduction in threat beliefs related to FOH; lower BG levels; and reduced levels of depression and anxiety. Clinical implications are discussed for treating FOH within primary care. Copyright © 2024 John Wiley & Sons.

The degree of safety behaviors to a safety stimulus predicts development of threat beliefs

Safety behaviors are behavioral responses that aim to prevent or minimize an imminent threat when confronting a feared stimulus. Despite its adaptive purpose, preliminary evidence suggests that unnecessary safety behaviors to a safety stimulus induce threat beliefs to it. By allowing participants to engage in safety behaviors dimensionally, this study tested whether the degree of safety behaviors to a safety stimulus predicts the subsequent level of threat expectancies to it. To this end, participants first acquired safety behaviors to a threat-related stimulus (A). Safety behaviors then became available only for one safety stimulus (C), but not to another safety stimulus (B). After engaging in safety behaviors to C, participants exhibited greater threat expectancies to C compared to B, albeit with a small effect size. Importantly, the degree of safety behaviors predicted an increase in threat expectancies. The current findings suggest that safety behaviors to safety stimuli are linked to the development of threat beliefs.

Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial)

BackgroundPersecutory delusions are strong threat beliefs about others’ negative intentions. They can have a major impact on patients’ day-to-day life. The Feeling Safe Programme is a new translational cognitive-behaviour therapy that helps patients modify threat beliefs and relearn safety by targeting key psychological causal factors. A different intervention approach, with growing international interest, is peer counselling to facilitate personal recovery. Combining these two approaches is a potential avenue to maximize patient outcomes. This combination of two different treatments will be tested as the Feeling Safe-NL Programme, which aims to promote psychological wellbeing. We will test whether Feeling Safe-NL is more effective and more cost-effective in improving mental wellbeing and reducing persecutory delusions than the current guideline intervention of formulation-based CBT for psychosis (CBTp).MethodsA single-blind parallel-group randomized controlled trial for 190 out-patients who experience persecutory delusions and low mental wellbeing. Patients will be randomized (1:1) to Feeling Safe-NL (Feeling Safe and peer counselling) or to formulation-based CBTp, both provided over a period of 6 months. Participants in both conditions are offered the possibility to self-monitor their recovery process. Blinded assessments will be conducted at 0, 6 (post-treatment), 12, and 18 months. The primary outcome is mental wellbeing. The overall effect over time (baseline to 18-month follow-up) and the effects at each timepoint will be determined. Secondary outcomes include the severity of the persecutory delusion, general paranoid ideation, patient-chosen therapy outcomes, and activity. Service use data and quality of life data will be collected for the health-economic evaluation.DiscussionThe Feeling Safe-NL Trial is the first to evaluate a treatment for people with persecutory delusions, while using mental wellbeing as the primary outcome. It will also provide the first evaluation of the combination of a peer counselling intervention and a CBT-based program for recovery from persecutory delusions.Trial registrationCurrent Controlled Trials ISRCTN25766661 (retrospectively registered 7 July 2022).

Explaining COVID-19 vaccination intention in younger adults using protection motivation theory.

While coronavirus disease 2019 (COVID-19) vaccine uptake has been encouraging in the United Kingdom, younger adults are more likely to be hesitant toward the vaccine. Protection Motivation Theory (PMT) has been applied to influenza vaccine acceptance, but there is a lack of research applying models of health behavior, such as PMT, to COVID-19 vaccine acceptance in younger adults. Additionally, prior research has suggested that coronavirus conspiracy beliefs may play a role in this acceptance. The present study assessed the association between COVID-19 vaccination intention in younger adults and PMT, including coronavirus conspiracy beliefs as specific threat beliefs, during the later stages of the vaccination program, with a correlational design using an online survey. The survey was completed by 301 individuals (177 vaccinated, 124 unvaccinated) aged 18-34 (67 males, 234 females). Respondents' Mage = 27.13 (SD = 4.68). A multiple linear regression was performed on unvaccinated individuals' responses. The model showed that four constructs from PMT-severity, self-efficacy, maladaptive response reward, and threat beliefs in the form of coronavirus conspiracy beliefs-were associated with intention to get vaccinated for COVID-19. An independent t test established that unvaccinated individuals had lower levels of education than vaccinated ones. Although further research is needed, interventions and campaigns addressing COVID-19 vaccine acceptance may need to use strategies increasing young adults' perceived severity of COVID-19 and their perceived ability to get vaccinated, while decreasing perceived reward of not getting vaccinated. Additionally, coronavirus conspiracy beliefs should be addressed in vaccine-hesitant individuals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reduction of costly safety behaviors after extinction with a generalization stimulus is determined by individual differences in generalization rules

Exposure-based treatment involves repeated presentation of feared stimuli or situations in the absence of perceived threat (i.e., extinction learning). However, the stimulus or situation of fear acquisition (CS+) is highly unlikely to be replicated and presented during treatment. Thereby, stimuli that resemble the CS+ (generalization stimuli; GSs) are typically presented. Preliminary evidence suggests that depending on how one generalizes fear (i.e., different generalization rules), presenting the same GS in extinction leads to differential effectiveness of extinction learning. The current study aimed to extend this finding to safety behaviors. After differential fear and avoidance conditioning, participants exhibited discrete generalization gradients that were consistent with their reported generalization rules (Similarity vs Linear). The Linear group showed stronger safety behaviors to a selected GS compared to the Similarity group, presumably due to higher threat expectancy. After extinction learning to this GS, the Linear group exhibited stronger reduction in safety behaviors generalization compared to the Similarity group. The results show that identifying distinct generalization rules allows one to predict expectancy violation to the extinction stimulus, in addition to corroborating the idea that strongly violating threat expectancy leads to better extinction learning and its generalization. With regard to clinical implications, identifying one's generalization rule (e.g., threat beliefs) help designing exposure sessions that evoke strong expectancy violation, enhancing the reduction in the generalization of maladaptive safety behaviors.

Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients

Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From 8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy.

Threat belief determines the degree of costly safety behavior: Assessing rule-based generalization of safety behavior with a dimensional measure of avoidance

Excessive generalization of safety behavior to innocuous stimuli that resemble a feared stimulus is oftentimes pathological especially with inflicted impairments. Safety behavior is conventionally assessed dichotomously, requiring multiple presentations of each test stimulus for assessing the proportion of safety behavior executed. Thus, the generalization gradient confounds with ongoing extinction learning during non-reinforced test trials. The present study employed a recently developed dimensional measure of avoidance to examine the extent of safety behavior generalization. We found that a dimensional measure of avoidance was able to assess the generalization gradients of safety behavior even when each test stimulus was presented once, thus minimizing the effect of ongoing extinction learning. Of equal importance is whether higher-order cognitive processes shape generalization of safety behavior. We found a range of distinct generalization gradients in safety behavior, which were highly consistent with participants’ verbally reported relational rules. This rule-based generalization parallels to how clinically anxious individuals develop different threat beliefs after trauma exposure, and models how these distinct threat beliefs determine the extent of safety behavior engagement.

Safety behaviors toward innocuous stimuli can maintain or increase threat beliefs

Safety behaviors can prevent or minimize a feared outcome. However, in relatively safe situations, they may be less adaptive, presumably because people will misattribute safety to these behaviors. This research aimed to investigate whether safety behaviors in safe situations can lead to increased threat beliefs. In Study 1, we aimed to replicate a fear conditioning study (N = 68 students) in which the experimental, but not the control group, received the opportunity to perform safety behavior to an innocuous stimulus. From before to after the availability of the safety behavior, threat beliefs persisted in the experimental group, while they decreased in the control group. In Study 2, we examined whether threat beliefs had actually increased for some individuals in the experimental group, using a multi-dataset latent class analysis on data from Study 1 and two earlier studies (N = 213). Results showed that about a quarter of individuals who performed safety behavior toward the innocuous stimulus showed increased threat expectancy to this cue, while virtually nobody in the control group exhibited an increase. Taken together, safety behavior in relatively safe situations may have maladaptive effects as it generally maintains and sometimes even increases threat beliefs.

Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis.

Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP. Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size. Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = - 0.31, p < 0.01, 95% CI: - 0.39, - 0.24) and disability (r = - 0.24, p < 0.01, 95% CI: - 0.40, - 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed. Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions. Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Do emotion regulation strategies mediate the attachment-paranoia association? An experimental study of repeated attachment imagery priming and stress buffering.

ObjectivesParanoia describes unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but limited research examines mechanisms of change and no studies examine how secure imagery may be implemented most effectively in clinical practice. In this study, we tested: (a) the causal impact of secure, anxious, and avoidant attachment imagery on paranoia and anxiety, (b) whether emotion regulation strategies mediate these relationships, and (c) whether secure imagery buffers against social stress.DesignWe utilized a longitudinal, experimental design.MethodA general population sample with high non‐clinical paranoia (N = 265) completed measures of paranoia, anxiety, and emotion regulation strategies. Participants were randomly allocated to secure, anxious, or avoidant conditions and repeated an imagery prime for four days prior to a social stress task.ResultsRelative to anxious and avoidant imagery, secure imagery decreased state paranoia and anxiety. These associations were not mediated by state emotion regulation strategies, and secure imagery did not buffer against stress. Exploratory analyses on trait variables revealed that: (a) hyperactivating strategies mediated the association between attachment anxiety and paranoia, and (b) suppression mediated the association between attachment avoidance and paranoia.ConclusionsSecure attachment imagery reduces state paranoia and anxiety and could be incorporated into psychotherapies to attenuate clinical paranoia. Measurement of state emotion regulation was problematic. Attachment imagery does not buffer stress; further research is required to test whether secure imagery facilitates recovery from stress. Attachment style is likely to account for trait paranoia via attachment‐congruent emotion regulation strategies. Research is now needed to determine if these strategies can be targeted to alleviate paranoia in clinical populations.

Change of risk behaviour in young people\xa0\u2013 the effectiveness of the trauma prevention programme P.A.R.T.Y. considering the effect of fear appeals and cognitive processes

BackgroundThe purpose of the present study was to examine the effectiveness of the injury awareness and prevention programme P.A.R.T.Y. (Prevent Alcohol and Risk-Related Trauma in Youth) in Germany. On a designated P.A R.T.Y. day, school classes spend a day in a trauma hospital experiencing the various wards through which a seriously injured person goes. A further goal of the study was to reveal indications of the programme’s mechanism of action by testing theory-based impact models of fear appeals and cognitive beliefs.MethodsIn a quasi-experimental longitudinal study with three measurement times the participants of 19 P.A.R.T.Y. days (n = 330), as well as pupils who did not attend the programme (n = 244), were interviewed with a standardised questionnaire. They reported risk behaviour, feelings of threat and cognitive beliefs about road traffic. The data were analysed using a meta-analytical approach to estimate an average effect size across the different P.A.R.T.Y. days. Path models were used to identify possible mechanisms of action.ResultsFor most of the parameters, small positive effects could be proven immediately after the P.A.R.T.Y. intervention. However, after four to 5 months only one statistically significant effect was found. Using path analytical models, important predictors for behavioural changes (e.g. self-efficacy) could be identified. But for these predictors no or only short-term effects were observed in the meta-analysis.ConclusionsFear appeals as used primarily in the P.A.R.T.Y. programme appear to cause behavioural changes only to a limited extent and only in the short-term, especially if the strengthening of psychosocial resources is not given sufficient consideration. The participants must also cognitively process the experiences in the hospital. Accordingly, consideration should be given to how the P.A.R.T.Y. program could be adapted to complement the fear appeal with cognitive components.

Relationship Between COVID-19 Threat Beliefs and Individual Differences in Demographics, Personality, and Related Beliefs.

Individual differences in demographics, personality, and other related beliefs are associated with coronavirus disease 2019 (COVID-19) threat beliefs. However, the relative contributions of these different types of individual differences to COVID-19 threat beliefs are not known. In this study, a total of 1,700 participants in Croatia (68% female; age 18–86 years) completed a survey that included questions about COVID-19 risks, questions about related beliefs including vaccination beliefs, trust in the health system, trust in scientists, and trust in the political system, the HEXACO 60 personality inventory, as well as demographic questions about gender, age, chronic diseases, and region. We used hierarchical regression analyses to examine the proportion of variance explained by demographics, personality, and other related beliefs. All three types of individual differences explained a part of the variance of COVID-19 threat beliefs, with related beliefs explaining the largest part. Personality facets explained a slightly larger amount of variance than personality factors. These results have implications for communication about COVID-19.

Reality Stems From Modality: Stereotype Threat Effects of a STEM Game in Augmented and Virtual Reality

This study examined the relationship between stereotype threat, game modality (augmented reality, virtual reality), and stereotypic beliefs about STEM fields. Results of a 2 [modality] x 2 [stereotype threat] factorial, between-subjects experiment with women participants (N = 64) suggest that gender stereotypes primed before playing the STEM game in AR induced stereotype threat, but induced stereotype reactance in VR. Specifically, for participants who played in AR, the stereotype-reinforcing prompt (compared to a counter-stereotype prompt) was associated with worse STEM-game performance, which mediated an increase in stereotypical beliefs about women in STEM. Conversely, for participants who played in VR, the stereotype-reinforcing prompt was associated with better STEM-game performance and more positive (i.e., counter-stereotypic) beliefs about women in STEM, though without mediation. These findings support the claim that stereotypes triggered in a STEM-gaming context have the potential to reinforce stereotypes in STEM fields. Researchers and practitioners should consider the implication that VR is potentially more male-stereotyped than AR, while AR makes stereotyped identity characteristics more accessible than VR.

Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial.

The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.

Bleuler revisited: on persecutory delusions and their resistance to therapy

Bleuler revisited: on persecutory delusions and their resistance to therapy

Does raising heart rate prior to a behavioural test enhance learning in cognitive therapy for anxiety? An experimental test for the treatment of fear of heights using virtual reality

BackgroundA key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests. MethodsSixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief. ResultsHeart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56). DiscussionAn increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.